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473 Treatment of small cell lung cancer (SCLC) in elderly patients (E.P.)
Therapy
- Combined
All five cases well tolerated the procedure for their poor performance status such as old age or low pulmonary functrion. Actual five year survival was confirmed by the long time follow up. Four of them were cancer free. One is recongized the recurrence in 3 years and 6 months that was the pleuritis carcinomatosa but she lived 5 years and 6 months after the surgery. Indication for the peripheral type of adenocarcinoma should be careful because pleural invasion of the cancer cell (P2) may cause the undetectable dissemination.
I
472
Rechallenge chemotherapy (CT) with neupogen@ (G-CSF) in relapsed small cell lung cancer
M. Vincent, W. Kocha, D. Ballingal, A. Tomiak, A. Malpage, L. Stitt, C. Johnson, P. Lopez, G. Goss. (OCTRF), S. Spadafora (Sault Ste. Marie Hospital), L.A. Hewih (Amgen), Oh/, Canada Patients (pts) who have remissions of 22 months off initial CT can often be reinduced with the same CT. Second remissions are usually short, due either to drug resistance (DR) or myelosuppression compromising dose intensity. G-CSF was added to determine if standard dose intensity could be maintained, potentially allowing the role of DR to be better defined. We report on 28 pts of a planned 44, accrued since 3/94; all had a 1st remission ~2 months off CT. Only prior thoracic and/or brain FIT was allowed. Initial CT was standard, cyclophosphamide/anthracycline/vincristine alternating with cisplatin (CIS)/etoposide (E). Rechallenge CT comprised only CIS 25 mg/m2 and E 100 mg/m’ dl-3, q3/52 with G-CSF 230 wg/m* d4-17. Of 24 evaluable, 11 achieved a PR (46%, 95% Cl: 2666%), 11 stable disease and 2 progressive disease; of 26 who are off-study, 20 have died. Mean (and median) no. of cycles received IS 4.5, and 12 pts received ~6 cycles. Median survival is an encouraging 7 mths. No toxic deaths occurred and significant nephro- or neurotoxicity did not occur. OccasIonal dose reductions and delays occurred, but of 12 pts receiving their 6th cycle, IO had it at full dose and 11 had it on time. Grade IV neutropenia occurred in 5 and febrile neutropenia in 5 of 108 cycles. Grade IV thrombocytopenia occurred in 2 cycles with 1 episode of major bleeding. Rechallenge CT can be safely delivered at conventional dose intensity over at least 6 cycles, using G-CSF. Our 46% response rate sets a bench mark by which to judge claims of non-cross resistance for non-identical CT. Relapsed disease is often sensitive to the original CT, implying a value to dose maintenance with G-CSF during both initial and rechallenge CT.
I
473
Treatment of small cell lung cancer (SCLC) in elderly patients (E.P.)
A. Paccagnella, A. Favaretto, L. Friso ‘, F. Oniga, L. Ossana, M.V. Fiorentino. Departments of Medical Oncology; ’ RadIotherapy, Azienda Ospedaliera, Padova 1-35128, ltaly Aim: To analyze the treatment outcome for E.P. (i.e. older than 70 yrs) affected by SCLC treated at our institution with the same protocol and entry criteria as younger pts. Results: From 1980 to 1988, 286 patients (M/F: 262124) were treated; 254 (88%) were younger than 70 (Y.P.) while 32 (12%) were E.P.. Pt. characteristics were similar in both age groups: median PS was 80% vs 80%, increased LDH 46% vs 47%, weight loss 55% vs 53%, limited disease (LD) stage 58% vs 56%, stages I-II 18% vs 18%, IIIA 26% vs 31%, IIIB 17.3% vs 15.6%, IV 38.2% vs 34.4%, operable pts 35% vs 31% respectively in Y.P. and E.P.. Surgery, however, was performed in 73 (28.7%) Y.P. and in only 6 (18.8%) E.P.. Chemotherapy (CT) consisted of 6 courses of alternating CAViPE for extensive disease pts.. LD pts were treated with 4 cycles of CT plus surgery in operable pts; RT (44Gy) followed CT in inoperable pts. Two pts had an early death before starting treatment, 3 pts were submitted only to surgery for refusal of CT, all in Y.P. group. In 44 pts surgery was followed by adjuvant CT. A total of 237 pts were submitted to primary CT, 210 pts were Y.P., 27 E.P.: objective response rates were 72% and 63% respectively, with 26.7% (56 pts.) and 22.2% (6 pts.) CR. Median survival was 11.6 and 12 months and 3 yrs survivals were 18% and 17.8%. Cox proportional hazard survival analysis showed no srgnificant differences by age. Conclusions: Compliance, responses and survival were similar in Y.P. and E.P. treated for SCLC. Thus an aggressive therapeutical approach seems to be justified in selected patients older than 70 yrs.
Modali
474 L-l
121
Therapy
Results of surgery for locally advanced 3B lung cancer
T4 and stage
H.-E. Yoon ‘, S. Takeda’, M. Minami ‘, 0. Kuwahara 2, T. Mori 3, T. Yasumitu 4, H. Matsuda ’ ’ Osaka Univ. First Dept. of Surg.; 2Toneyama Hosp; 3Kinki-chuo Hosp; 4Habikino Hasp, Osaka, Japan To determine which factors may affect the prognosis after surgery for locally advanced lung cancer (LC), we retrospectively analyzed the patients of pathological T4(pT4)-stage3B without pleural dissemination, There were 87 patients (2.5%) of pT4stage3B without pleural dissemination out of 3497 patients who undertook thoracotomy in our institutes from 1975 to 1994. There were 55 squamous cell, 16 adeno-, 8 large cell, 2 small cell and 8 other type carcinomas. Surgical procedures consisted of 44 pneumonectomies, 30 lobectomies, 1 partial resection and 12 explorations. Involved organs consisted of 11 of trachea or carina, 41 of atriums or pulmonary artery, 11 of superior vena cava, 14 of aorta, 8 of esophagus, 8 of vertebra, 2 of liver and 11 of mediastinum. Twenty two patients (25%) received adjuvant chemotherapy and 41 patients (47%) received radiation therapy. Results are summarized in the following tables. Table 1 Prognosrs after surgery
Total Complete resectron Incomplete resectron Exploratron
Number of cases
MST (months)
a7 28
10 16 9 6
47
12
Survival rate (%) 3 years
5 years
14 32’ 6
5 7’ 4
0
0
‘vs Incomplete resection, p c 0.05 by logrank test Table 2. Complete vs. incomplete resectron
pN2-3
Complete resection (n) 19 9
22 35
Single involved organ+ Multiple involved organs
25 3
20
pNO-1+
Incomplete resection (n)
39
+ -p c; 0.05 by 2’ test Based on these results we concluded that surgery should be considered as one of multimodal therapies for locally advanced T4 - stage3B LC with NO-I and smgle involved organ.
14751 A correlation hypothesis between personality and clinical history of lung cancer patients V. Beltrami, A. Buonsanto, Univ. of Chiefi, ltaly
E. Mascitelli,
F. Santobuono.
profile
De@. of Surgery,
A correlation between the personality profile and the clinical history in lung cancer patients was studied. Selection of cases Included in the sample only surgical patients with a medium educational level and a tested capability to understand a specific questionnaire. One hundred and seventy patients were selected and the so-called C.R.I.C.S. (Clrnician-Rated Inventory of Character Style) was applied. Score variations were recorded after curative resection as well as during relapse. Changes in the character profile pattern were found in all subjects who experienced the disease and its surgical treatment. These changes occurred either in “regression’‘-with an increase of schizoid, narcissistic or hysterical aspects -or in a “positive evolution”, with a decrease of paranoid traits and into a depressive position. The two groups of responses demonstrated a similar percentage.
L476
Therapy and distant result for multiple lung tumor
metastasis
K. Adachi, I. Hioki, Y. Syomura, T. Tokui, M. Talao, K. Tani, T. Shimono, S. Namikawa, I. Yada. Me Univ., Tsu, Japan Purpose: We investigated the principle of lung partial resection for metastatic tumor without the number of metastatic tumor and metastatic lobe. Object: Metastatic lung tumor (1972.4.-1995.12.), case 177 operation 220. Result: (1) Partial resection: 149 (68%)
- Combined
All five cases well tolerated the procedure for their poor performance status such as old age or low pulmonary functrion. Actual five year survival was confirmed by the long time follow up. Four of them were cancer free. One is recongized the recurrence in 3 years and 6 months that was the pleuritis carcinomatosa but she lived 5 years and 6 months after the surgery. Indication for the peripheral type of adenocarcinoma should be careful because pleural invasion of the cancer cell (P2) may cause the undetectable dissemination.
I
472
Rechallenge chemotherapy (CT) with neupogen@ (G-CSF) in relapsed small cell lung cancer
M. Vincent, W. Kocha, D. Ballingal, A. Tomiak, A. Malpage, L. Stitt, C. Johnson, P. Lopez, G. Goss. (OCTRF), S. Spadafora (Sault Ste. Marie Hospital), L.A. Hewih (Amgen), Oh/, Canada Patients (pts) who have remissions of 22 months off initial CT can often be reinduced with the same CT. Second remissions are usually short, due either to drug resistance (DR) or myelosuppression compromising dose intensity. G-CSF was added to determine if standard dose intensity could be maintained, potentially allowing the role of DR to be better defined. We report on 28 pts of a planned 44, accrued since 3/94; all had a 1st remission ~2 months off CT. Only prior thoracic and/or brain FIT was allowed. Initial CT was standard, cyclophosphamide/anthracycline/vincristine alternating with cisplatin (CIS)/etoposide (E). Rechallenge CT comprised only CIS 25 mg/m2 and E 100 mg/m’ dl-3, q3/52 with G-CSF 230 wg/m* d4-17. Of 24 evaluable, 11 achieved a PR (46%, 95% Cl: 2666%), 11 stable disease and 2 progressive disease; of 26 who are off-study, 20 have died. Mean (and median) no. of cycles received IS 4.5, and 12 pts received ~6 cycles. Median survival is an encouraging 7 mths. No toxic deaths occurred and significant nephro- or neurotoxicity did not occur. OccasIonal dose reductions and delays occurred, but of 12 pts receiving their 6th cycle, IO had it at full dose and 11 had it on time. Grade IV neutropenia occurred in 5 and febrile neutropenia in 5 of 108 cycles. Grade IV thrombocytopenia occurred in 2 cycles with 1 episode of major bleeding. Rechallenge CT can be safely delivered at conventional dose intensity over at least 6 cycles, using G-CSF. Our 46% response rate sets a bench mark by which to judge claims of non-cross resistance for non-identical CT. Relapsed disease is often sensitive to the original CT, implying a value to dose maintenance with G-CSF during both initial and rechallenge CT.
I
473
Treatment of small cell lung cancer (SCLC) in elderly patients (E.P.)
A. Paccagnella, A. Favaretto, L. Friso ‘, F. Oniga, L. Ossana, M.V. Fiorentino. Departments of Medical Oncology; ’ RadIotherapy, Azienda Ospedaliera, Padova 1-35128, ltaly Aim: To analyze the treatment outcome for E.P. (i.e. older than 70 yrs) affected by SCLC treated at our institution with the same protocol and entry criteria as younger pts. Results: From 1980 to 1988, 286 patients (M/F: 262124) were treated; 254 (88%) were younger than 70 (Y.P.) while 32 (12%) were E.P.. Pt. characteristics were similar in both age groups: median PS was 80% vs 80%, increased LDH 46% vs 47%, weight loss 55% vs 53%, limited disease (LD) stage 58% vs 56%, stages I-II 18% vs 18%, IIIA 26% vs 31%, IIIB 17.3% vs 15.6%, IV 38.2% vs 34.4%, operable pts 35% vs 31% respectively in Y.P. and E.P.. Surgery, however, was performed in 73 (28.7%) Y.P. and in only 6 (18.8%) E.P.. Chemotherapy (CT) consisted of 6 courses of alternating CAViPE for extensive disease pts.. LD pts were treated with 4 cycles of CT plus surgery in operable pts; RT (44Gy) followed CT in inoperable pts. Two pts had an early death before starting treatment, 3 pts were submitted only to surgery for refusal of CT, all in Y.P. group. In 44 pts surgery was followed by adjuvant CT. A total of 237 pts were submitted to primary CT, 210 pts were Y.P., 27 E.P.: objective response rates were 72% and 63% respectively, with 26.7% (56 pts.) and 22.2% (6 pts.) CR. Median survival was 11.6 and 12 months and 3 yrs survivals were 18% and 17.8%. Cox proportional hazard survival analysis showed no srgnificant differences by age. Conclusions: Compliance, responses and survival were similar in Y.P. and E.P. treated for SCLC. Thus an aggressive therapeutical approach seems to be justified in selected patients older than 70 yrs.
Modali
474 L-l
121
Therapy
Results of surgery for locally advanced 3B lung cancer
T4 and stage
H.-E. Yoon ‘, S. Takeda’, M. Minami ‘, 0. Kuwahara 2, T. Mori 3, T. Yasumitu 4, H. Matsuda ’ ’ Osaka Univ. First Dept. of Surg.; 2Toneyama Hosp; 3Kinki-chuo Hosp; 4Habikino Hasp, Osaka, Japan To determine which factors may affect the prognosis after surgery for locally advanced lung cancer (LC), we retrospectively analyzed the patients of pathological T4(pT4)-stage3B without pleural dissemination, There were 87 patients (2.5%) of pT4stage3B without pleural dissemination out of 3497 patients who undertook thoracotomy in our institutes from 1975 to 1994. There were 55 squamous cell, 16 adeno-, 8 large cell, 2 small cell and 8 other type carcinomas. Surgical procedures consisted of 44 pneumonectomies, 30 lobectomies, 1 partial resection and 12 explorations. Involved organs consisted of 11 of trachea or carina, 41 of atriums or pulmonary artery, 11 of superior vena cava, 14 of aorta, 8 of esophagus, 8 of vertebra, 2 of liver and 11 of mediastinum. Twenty two patients (25%) received adjuvant chemotherapy and 41 patients (47%) received radiation therapy. Results are summarized in the following tables. Table 1 Prognosrs after surgery
Total Complete resectron Incomplete resectron Exploratron
Number of cases
MST (months)
a7 28
10 16 9 6
47
12
Survival rate (%) 3 years
5 years
14 32’ 6
5 7’ 4
0
0
‘vs Incomplete resection, p c 0.05 by logrank test Table 2. Complete vs. incomplete resectron
pN2-3
Complete resection (n) 19 9
22 35
Single involved organ+ Multiple involved organs
25 3
20
pNO-1+
Incomplete resection (n)
39
+ -p c; 0.05 by 2’ test Based on these results we concluded that surgery should be considered as one of multimodal therapies for locally advanced T4 - stage3B LC with NO-I and smgle involved organ.
14751 A correlation hypothesis between personality and clinical history of lung cancer patients V. Beltrami, A. Buonsanto, Univ. of Chiefi, ltaly
E. Mascitelli,
F. Santobuono.
profile
De@. of Surgery,
A correlation between the personality profile and the clinical history in lung cancer patients was studied. Selection of cases Included in the sample only surgical patients with a medium educational level and a tested capability to understand a specific questionnaire. One hundred and seventy patients were selected and the so-called C.R.I.C.S. (Clrnician-Rated Inventory of Character Style) was applied. Score variations were recorded after curative resection as well as during relapse. Changes in the character profile pattern were found in all subjects who experienced the disease and its surgical treatment. These changes occurred either in “regression’‘-with an increase of schizoid, narcissistic or hysterical aspects -or in a “positive evolution”, with a decrease of paranoid traits and into a depressive position. The two groups of responses demonstrated a similar percentage.
L476
Therapy and distant result for multiple lung tumor
metastasis
K. Adachi, I. Hioki, Y. Syomura, T. Tokui, M. Talao, K. Tani, T. Shimono, S. Namikawa, I. Yada. Me Univ., Tsu, Japan Purpose: We investigated the principle of lung partial resection for metastatic tumor without the number of metastatic tumor and metastatic lobe. Object: Metastatic lung tumor (1972.4.-1995.12.), case 177 operation 220. Result: (1) Partial resection: 149 (68%)